Permanent pacemaker implantation rates following cardiac surgery in the modern era
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ORIGINAL ARTICLE
Permanent pacemaker implantation rates following cardiac surgery in the modern era Jason Kho 1
&
Adam Ioannou 2 & Katie E. O’Sullivan 3 & Mark Jones 3
Received: 23 April 2020 / Accepted: 5 May 2020 # The Author(s) 2020
Abstract Aims The aim of this study was to evaluate the incidence of permanent pacemaker (PPM) implantation after cardiac surgery in our institution and investigate risk factors for PPM dependency to provide patients with accurate incidence figures at the time of consent for surgery. Methods Data was collected retrospectively from a single tertiary institution from October 2018 to April 2019 inclusive of 403 patients. Incidence of PPM implantation after various cardiac operations was evaluated. A univariate analysis was carried out to identify the independent risk factors related to PPM implantation. Results Ten patients required a PPM (2.48%). The most common indication for PPM implantation post-cardiac surgery was complete heart block (N = 7, 70%) followed by bradycardia/pauses (N = 2, 20%) and sick sinus syndrome (N = 1, 10%). PPM implantation after coronary artery bypass graft (CABG) surgery was the lowest (0.63%), while combined CABG and valve operations had the highest incidence (5.97%). Independent risk predictors for PPM implantation included female gender (p = 0.03), rheumatic heart disease (p = 0.008), pulmonary hypertension (p = 0.01), redo operations (p = 0.002), mitral valve procedures (p = 0.001), tricuspid valve procedures (p = 0.0003) and combined mitral and tricuspid valve procedures (p = 0.0001). Average length of intensive care unit (ICU)/high-dependency unit (HDU) stay was significantly prolonged for patients who required a PPM post-cardiac surgery. Conclusion As clinicians, it can be challenging to provide our patients with accurate information on the risk of PPM implantation relative to their operation. A unit-specific data may be a more accurate method of informing our patients on this risk. Keywords Cardiac surgery . Cardiology . Modern era . Permanent pacemaker
Introduction The prevalence of permanent pacemaker (PPM) implantation following cardiac surgery had been reported to be between 0.4 and 6%, with the lowest incidence following coronary artery bypass grafting (CABG) and the highest following valve surgery [1, 2]. Common indications for PPM post-cardiac surgery include bradyarrhythmias, such as atrioventricular (AV) block, sinus node dysfunction and atrial fibrillation (AF) with * Mark Jones [email protected] 1
Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham, UK
2
Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
3
Royal Victoria Hospital, Belfast Health and Social Care Trust, 274 Grosvenor Road, Belfast BT12 6BA, UK
a slow ventricular response [3]. These arrhythmias can occur secondary to myocardial injury that is sustained during the operation, resulting in damage to the conduction system of the heart. The pathophysiological mechanisms causing perioperative myocardial injury include me
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